Alcoholism, also known as alcohol dependence, is a disabling addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing. Like other drug addictions, alcoholism is medically defined as a treatable disease. The term "alcoholism" is a widely used term first coined in 1849 by Magnus Huss, but in medicine the term was replaced by "alcohol abuse" and "alcohol dependence" in the 1980s DSM III. Similarly in 1979 an expert World Health Organisation committee disfavoured the use of "alcoholism" as a diagnostic entity, preferring the category of "alcohol dependence syndrome". In the 19th and early 20th centuries, alcohol dependence was called dipsomania before the term "alcoholism" replaced it.
The biological mechanisms underpinning alcoholism are uncertain, however, risk factors include social environment, stress, mental health, genetic predisposition, age, ethnic group, and sex. Long-term alcohol abuse produces physiological changes in the brain such as tolerance and physical dependence. Such brain chemistry changes maintain the alcoholic's compulsive inability to stop drinking and result in alcohol withdrawal syndrome upon discontinuation of alcohol consumption. Alcohol damages almost every organ in the body, including the brain; because of the cumulative toxic effects of chronic alcohol abuse, the alcoholic risks suffering a range of medical and psychiatric disorders. Alcoholism has profound social consequences for alcoholics and the people of their lives.
Alcoholism is the cyclic presence of tolerance, withdrawal, and excessive alcohol use; the drinker's inability to control such compulsive drinking, despite awareness of its harm to his or her health, indicate that the person might be an alcoholic. Questionnaire-based screening is a method of detecting harmful drinking patterns, including alcoholism. Alcohol detoxification is conducted to withdraw the alcoholic person from drinking alcohol, usually with cross-tolerance drugs, e.g. benzodiazepines to manage withdrawal symptoms. Post-medical care, such as group therapy, or self-help groups, usually is required to maintain alcoholic abstention. Often, alcoholics also are addicted to other drugs, most often benzodiazepines, which might require additional medical treatment. The alcoholic woman is more sensitive to alcohol's deleterious physical, cerebral, and mental effects, and increased social stigma, in relation to a man, for being an alcoholic. The World Health Organisation estimates that there are 140 million alcoholics worldwide.
Classification and terminology
Misuse, problem use, abuse, and heavy use refers to improper use of alcohol which may cause physical, social, or moral harm to the drinker. Moderate use is defined by The Dietary Guidelines for Americans as no more than two alcoholic beverages per day for men and no more than one alcoholic beverage per day for women.
The term "alcoholism" is commonly used, but poorly defined. The WHO defines alcoholism as "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO Expert Committee. The Big Book (from Alcoholics Anonymous) states that once a person is an alcoholic, he always is an alcoholic, but does not define what is meant by the term "alcoholic" in this context. In 1960, Bill W. said:
- We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady -- a far safer term for us to use.
In professional and research contexts, the term "alcoholism" sometimes encompasses both alcohol abuse and alcohol dependence. and sometimes is considered equivalent to alcohol dependence.
In psychology and psychiatry, the DSM is the most common global standard, while in medicine, the standard is ICD. The terms they recommend are similar but not identical:
||"alcohol abuse" and "alcohol dependence"
- alcohol abuse = repeated use despite recurrent adverse consequences.
- alcohol dependence = alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.
The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence". It has been suggested that DSM-V merge alcohol abuse and alcohol dependence into a single new entry, named "alcohol-use disorder".
||"alcohol harmful use" and "alcohol dependence syndrome"
||Definitions are similar to that of the DSM-IV. The World Health Organisation uses the term alcohol dependence syndrome rather than alcoholism. The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence. The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.
Despite the imprecision inherent in the term, there have been attempts to define how the word "alcoholism" should be interpreted when encountered. In 1992, it was defined by the NCADD and ASAM as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking." MeSH has had an entry for "alcoholism" since 1999, and references the 1992 definition.
1904 advertisement describing alcoholism as a disease.
Historically the name dipsomania was coined by German physician Dr. C. W. Hufeland in 1819 before it was superseded by alcoholism. The term "alcoholism" was first used in 1849 by the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol.
AA describes alcoholism as an illness that involves a physical allergy:p.28 and a mental obsession.:p.23 Note that the definition of "allergy" used in this context is not the same as used in modern medicine. The doctor and addiction specialist Dr. William D. Silkworth M.D. writes on behalf of AA that "Alcoholics suffer from a "(physical) craving beyond mental control".:XXVI
A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism. Jellinek's definition restricted the use of the word "alcoholism" to those showing a particular natural history. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.
A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele, argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term "heavy drinking" when discussing the negative effects of alcohol consumption.
Signs and symptoms
Symptoms of long term alcohol misuse
Alcoholism is characterised by an increased tolerance of and physical dependence on alcohol, affecting an individual's ability to control alcohol consumption safely. These characteristics are believed to play a role in impeding an alcoholic's ability to stop drinking. Alcoholism can have adverse effects on mental health, causing psychiatric disorders to develop and an increased risk of suicide.
Long term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and cancer. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.
Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men. Examples of long term complications include brain, heart, and liver damage and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause. Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking.
Long term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are not uncommon; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.
Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. Panic disorder can develop or worsen as a direct result of long term alcohol misuse.
The co-occurrence of major depressive disorder and alcoholism is well documented. Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes). Additional use of other drugs may increase the risk of depression.
Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder. Women with alcoholism are more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and the intoxicating effects of alcohol. Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault. Alcoholism is associated with loss of employment, which can lead to financial problems. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior, and may lead to a criminal sentence.
An alcoholic's behavior and mental impairment, while drunk, can profoundly impact those surrounding them and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of the alcoholic's children.
As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed. Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure. Other neurotransmitter systems are also involved, especially dopamine and NMDA.
Acute withdrawal symptoms tend to subside after one to three weeks. Less severe symptoms (e.g. insomnia and anxiety, anhedonia) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system restore alcohol tolerance and GABA functioning towards normal.
A complex mixture of genetic and environmental factors influence the risk of the development of alcoholism. Genes which influence the metabolism of alcohol also influence the risk of alcoholism, and may be indicated by a family history of alcoholism. One paper has found that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. Individuals who have a genetic disposition to alcoholism are also more likely to begin drinking at an earlier age than average. Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism, and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.
Severe childhood trauma is also associated with an general increase in the risk of drug dependency. Lack of peer and family support is associated with a increased risk of alcoholism developing. Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.
Genetic differences exist between different racial groups which affect the risk of developing alcohol dependence. For example, there are differences between African, East Asian and Indo-racial groups in how they metabolize alcohol. These genetic factors are believed to, in part, explain the differing rates of alcohol dependence among racial groups. The alcohol dehydrogenase allele ADH1 B*3 causes a more rapid metabolism of alcohol. The allele ADH1 B*3 is only found in those of African descent and certain Native American tribes. African and native Americans with this allele have a reduced risk of developing alcoholism. Native Americans however, have a significantly higher rate of alcoholism than average; it is unclear why this is the case. Other risk factors such as cultural environmental effects e.g. trauma have been proposed to explain the higher rates of alcoholism among Native Americans compared to alcoholism levels in caucasians.
Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs). This can be attributed to many reasons, the main being that women have less body water than men. A given amount of alcohol, therefore becomes more highly concentrated in a woman's body. A given amount of alcohol causes greater intoxication for women due to different hormone release compared to men.
Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol abuse. This is more of a barrier for women than men. Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic. In contrast, reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to publicly display their drinking, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic.
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.
Two "yes" responses indicate that the respondent should be investigated further. The questionnaire asks the following questions:
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
- The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol related problems; however, it has limitations in people with less severe alcohol related problems, white women and college students.
Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses, driving under the influence being the most common. The Alcohol Use Disorders Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions â a high score earning a deeper investigation. The Paddington Alcohol Test (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.
Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism does not have a single causeâincluding geneticâbut that genes do play an important role "by affecting processes in the body and brain that interact with one another and with an individual's life experiences to produce protection or susceptibility". They also report that fewer than a dozen alcoholism-related genes have been identified, but that more likely await discovery.
At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin-releasing drugs like alcohol. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.
The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared to one another. According to the DSM-IV, an alcohol dependence diagnosis is:
... maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae
Urine and blood tests
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:
However, none of these blood tests for biological markers are as sensitive as screening questionnaires.
The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. Targeting adolescents and young adults is regarded as an important step to reduce the harm of alcohol abuse. Increasing the age at which licit drugs of abuse such as alcohol can be purchased, the banning or restricting advertising of alcohol has been recommended as additional ways of reducing the harm of alcohol dependence and abuse. Credible, evidence based educational campaigns in the mass media about the consequences of alcohol abuse have been recommended. Guidelines for parents to prevent alcohol abuse amongst adolescents, and for helping young people with mental health problems have also been suggested.
Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as benzodiazepines, that have similar effects to prevent alcohol withdrawal. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow-up detoxification with an appropriate treatment program for alcohol dependence or abuse in order to reduce the risk of relapse.
Group therapy and psychotherapy
Various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Alcoholics Anonymous was one of the first organizations formed to provide mutual, nonprofessional counseling, and it is still the largest. Others include LifeRing Secular Recovery, SMART Recovery, and Women For Sobriety.
Rationing and moderation
Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7 percent of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency. A follow-up study, using the same subjects that were judged to be in remission in 2001â2002, examined the rates of return to problem drinking in 2004â2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics. A long-term (60 year) follow-up of two groups of alcoholic men concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."
A variety of medications may be prescribed as part of treatment for alcoholism.
Medications currently in use
- Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and the related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50 percent.
- Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opiates. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence when naltrexone is in the body there is a reduction in the pleasurable effects from consuming alcohol. Naltrexone is also used in an alcoholism treatment method called the Sinclair Method, which treats patients through a combination of Naltrexone and continued drinking.
- Topamax (topiramate), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence. A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.
Medications which may worsen outcome
- Benzodiazepines, whilst useful in the management of acute alcohol withdrawal, if used long-term cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs are commonly prescribed to alcoholics for insomnia or anxiety management. Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Patients often mistakenly think that they are sober despite continuing to take benzodiazepines. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for relapse into alcohol abuse. Taper regimes of 6â12 months have been found to be the most successful, with reduced intensity of withdrawal.
Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcohol dependence is a benzodiazepine dependence, with studies showing 10â20 percent of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepines. Benzodiazepines increase cravings for alcohol and the volume of alcohol consumed by problem drinkers. Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences.
Dependence on other sedative hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not managed properly.
Disability-adjusted life year
for alcohol use disorders per 100,000 inhabitants in 2002.
no data less than 50 50â150 150â250 250â350 350â450 450â550 550â650 650â750 750â850 850â950 950â1050 more than 1050
Substance use disorders are a major public health problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol." In the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001. About 12% of American adults have had an alcohol dependence problem at some time in their life. The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence. In the United States and western Europe 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet criteria for alcoholism.
Within the medical and scientific communities, there is broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."
Alcoholism has a higher prevalence among men, though in recent decades, the proportion of female alcoholics has increased. Current evidence indicates that in both men and women, alcoholism is 50â60 percent genetically determined, leaving 40â50 percent for environmental influences. Most alcoholics develop alcoholism during adolescence or young adulthood.
A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adults meeting the criteria for alcohol dependence and found that after one year, some met the authors' criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered â made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers.
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."
The most common cause of death in alcoholics is from cardiovascular complications. There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse. Approximately 18 percent of alcoholics commit suicide, and research has found that over 50 percent of all suicides are associated with alcohol or drug dependence. The figure is higher for adolescents, with alcohol or drug misuse playing a role in up to 70 percent of suicides.
Alcohol has a long history of use and misuse throughout recorded human history. Biblical, Egyptian and Babylonian sources record history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and others its abuse was condemned. Excessive alcohol misuse and drunkenness were recognised as causing problems thousand of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 1700s. In 1647 a Greek monkprohibition of alcohol being considered and eventually enforced briefly in America. In 2005 the cost of alcohol dependence and abuse was estimated to cost the USA economy approximately 220 billion dollars per year, more than cancer and obesity.
was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis and internal bleeding. In 1920 the effects of alcohol abuse and chronic drunkenness led to the failed
Society and culture
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there are also significant social costs to both the alcoholic and their family and friends. For instance, alcohol consumption by a pregnant woman can lead to fetal alcohol syndrome, an incurable and damaging condition.
Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six percent of a country's GDP. One Australian estimate pegged alcohol's social costs at 24 percent of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41 percent. One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as â£18.5â20 billion.
Stereotypes of alcoholics are often found in fiction and popular culture. The 'town drunk' is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers. Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.
- ^ MedlinePlus; National Library of Medicine (15 January 2009). "Alcoholism". National Institute of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm.
- ^ Department of Health and Human Services. "Alcohol Dependence (Alcoholism)" (PDF). National Institutes of Health. http://www.nih.gov/about/researchresultsforthepublic/AlcoholDependenceAlcoholism.pdf.
- ^ American Medical Association. "DEFINITIONS" (PDF). USA: AMA. http://www.ama-assn.org/ama1/pub/upload/mm/388/alcoholism_treatable.pdf.
- ^ a b c "Diagnostic Criteria for Alcohol Abuse and Dependence - Alcohol Alert No. 30-1995". http://pubs.niaaa.nih.gov/publications/aa30.htm. Retrieved 17 April 2010.
- ^ a b WHO. "Lexicon of alcohol and drug terms published by the World Health Organization". World Health Organisation. http://www.who.int/substance_abuse/terminology/who_lexicon/en/.
- ^ Tracy, Sarah J. (25 May 2005). Alcoholism in America: from reconstruction to prohibition. Baltimore: Johns Hopkins University Press. pp. 31â52. ISBN 978-0-8018-8119-0. http://books.google.com/?id=JkYyd4qmme0C&pg=PA31.
- ^ Glavas MM, Weinberg J (2006). "Stress, Alcohol Consumption, and the Hypothalamic-Pituitary-Adrenal Axis". in Yehuda S, Mostofsky DI. Nutrients, Stress, and Medical Disorders. Totowa, NJ: Humana Press. pp. 165â183. ISBN 978-1-58829-432-6.
- ^ Agarwal-Kozlowski, K.; Agarwal, DP. (Apr 2000). "[Genetic predisposition for alcoholism]". Ther Umsch 57 (4): 179â84. PMID 10804873.
- ^ Chen, CY.; Storr, CL.; Anthony, JC. (Mar 2009). "Early-onset drug use and risk for drug dependence problems.". Addict Behav 34 (3): 319â22. doi:10.1016/j.addbeh.2008.10.021. PMID 19022584.
- ^ a b c Hoffman, PL.; Tabakoff, B. (Jul 1996). "Alcohol dependence: a commentary on mechanisms.". Alcohol Alcohol 31 (4): 333â40. PMID 8879279.
- ^ Caan, Woody; Belleroche, Jackie de, eds (11 April 2002). Drink, Drugs and Dependence: From Science to Clinical Practice (1st ed.). Routledge. pp. 19â20. ISBN 978-0-415-27891-1. http://books.google.com/?id=nPvbDUw4w5QC.
- ^ a b SchadΓ©, Johannes Petrus (October 2006). The Complete Encyclopedia of Medicine and Health. Foreign Media Books. pp. 132â133. ISBN 978-1-60136-001-4. http://books.google.com/?id=j8DuEHxSCU4C.
- ^ a b Gifford, Maria (22 October 2009). Alcoholism (Biographies of Disease). Greenwood Press. pp. 89â91. ISBN 978-0-313-35908-8. http://books.google.com/?id=2OJV12astRUC.
- ^ a b Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 31 July 1994. ISBN 978-0-89042-025-6. http://books.google.com/?id=W-BGAAAAMAAJ.
- ^ a b Kahan, M. (Apr 1996). "Identifying and managing problem drinkers.". Can Fam Physician 42: 661â71. PMID 8653034.
- ^ a b Blondell, RD. (Feb 2005). "Ambulatory detoxification of patients with alcohol dependence.". Am Fam Physician 71 (3): 495â502. PMID 15712624.
- ^ a b Morgan-Lopez, AA.; Fals-Stewart, W. (May 2006). "Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions.". Exp Clin Psychopharmacol 14 (2): 265â73. doi:10.1037/1064-1222.214.171.1245. PMID 16756430.
- ^ a b Soyka, M.; Helten, C.; Scharfenberg, CO. (2001). "[Psychotherapy of alcohol addictionâprinciples and new findings of therapy research]". Wien Med Wochenschr 151 (15â17): 380â8; discussion 389. PMID 11603209.
- ^ a b Johansson BA, Berglund M, Hanson M, PΓΆhlΓ©n C, Persson I (November 2003). "Dependence on legal psychotropic drugs among alcoholics" (PDF). Alcohol Alcohol. 38 (6): 613â8. doi:10.1093/alcalc/agg123. ISSN 0735-0414. PMID 14633651. http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613.
- ^ a b c d Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all (1998). "Alcoholism and alcohol abuse among women: report of the council on scientific affairs". Journal of women's health 7 (7): 861â870. doi:10.1089/jwh.1998.7.861.
- ^ a b c d Walter, H.; Gutierrez, K.; Ramskogler, K.; Hertling, I.; Dvorak, A.; Lesch, OM. (Nov 2003). "Gender-specific differences in alcoholism: implications for treatment.". Arch Womens Ment Health 6 (4): 253â8. doi:10.1007/s00737-003-0014-8. PMID 14628177.
- ^ a b Dr Gro Harlem Brundtland (19 February 2001). "WHO European Ministerial Conference on Young People and Alcohol". World Health Organisation. http://www.who.int/director-general/speeches/2001/english/20010219_youngpeoplealcohol.en.html.
- ^ a b Ms Leanne Riley (31 January 2003). "WHO to meet beverage company representatives to discuss health-related alcohol issues". World Health Organisation. http://www.who.int/mediacentre/news/releases/2003/pr6/en/index.html.
- ^ American Heritage Dictionaries (12 April 2006). The American Heritage dictionary of the English language (4 ed.). Boston: Houghton Mifflin. ISBN 978-0-618-70172-8. http://books.google.com/?id=uPCFIQAACAAJ. "To use wrongly or improperly; misuse: abuse alcohol"
- ^ "Dietary Guidelines for Americans 2005". USA: health.gov. 2005. http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm. Dietary Guidelines
- ^ Thomas F. McGovern; William L. White (20 May 2003). Alcohol Problems in the United States: Twenty Years of Treatment Perspective. Routledge. pp. 7â. ISBN 978-0-7890-2049-9. http://books.google.com/?id=3gRwmYohuooC&pg=PA7. Retrieved 17 April 2010.
- ^ alcoholism at Dorland's Medical Dictionary
- ^ a b VandenBos, Gary R. (15 July 2006). APA dictionary of psychology. Washington, DC: American Psychological Association. ISBN 978-1-59147-380-0. http://books.google.com/?id=OSoZAQAAIAAJ.
- ^ Martin CS, Chung T, Langenbucher JW (August 2008). "How should we revise diagnostic criteria for substance use disorders in the DSM-V?". J Abnorm Psychol 117 (3): 561â75. doi:10.1037/0021-843X.117.3.561. PMID 18729609. PMC 2701140. http://content.apa.org/journals/abn/117/3/561.
- ^ "Proposed Revision | APA DSM-5". http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=452#. Retrieved 17 April 2010.
- ^ "A System to Convert ICD Diagnostic Codes for Alcohol Research". http://www.cdc.gov/mmwr/preview/mmwrhtml/00000324.htm. Retrieved 17 April 2010.
- ^ Morse RM, Flavin DK (August 1992). "The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism". JAMA : the journal of the American Medical Association 268 (8): 1012â4. doi:10.1001/jama.268.8.1012. ISSN 0098-7484. PMID 1501306.
- ^ MeSH Alcoholism
- ^ Peters, Uwe Henrik (April 30, 2007). Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie. Urban Fischer bei Elsev. ISBN 978-3-437-15061-6.
- ^ Valverde, Mariana (1998). Diseases of the Will. Cambridge: Cambridge University Press. p. 48. ISBN 978-0-521-64469-3. http://books.google.com/?id=Kl5ugmvDgH0C&pg=PA48&lpg=PA48&dq=valentin+magnan+dipsomania.
- ^ Alcoholismus chronicus, eller Chronisk alkoholssjukdom:. Stockholm und Leipzig. 1852. http://books.google.com/?id=wt6r2Zw8sCEC&pg=PR5. Retrieved 19 February 2008.
- ^ a b c Anonymous; The first 100 members of AA (1939, 2001). Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism. New York City: Alcoholics Anonymous World Services. xxxii, 575 p.. ISBN 1-893007-16-2. http://www.aa.org.
- ^ "The Big Book Self Test:". intoaction.us. http://www.intoaction.us/SelfTest.html. Retrieved 19 February 2008.
- ^ Kay AB (2000). "Overview of 'allergy and allergic diseases: with a view to the future'". Br. Med. Bull. 56 (4): 843â64. doi:10.1258/0007142001903481. ISSN 0007-1420. PMID 11359624.
- ^ "OCTOBER 22 DEATHS". todayinsci.com. http://www.todayinsci.com/10/10_22.htm. Retrieved 18 February 2008.
- ^ a b Nora Volkow. "Science of Addiction" (PDF). American Medical Association. http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf.
- ^ Dunn, N; Cook (March 1999). "Psychiatric aspects of alcohol misuse.". Hospital medicine (London, England : 1998) 60 (3): 169â72. ISSN 1462-3935. PMID 10476237.
- ^ a b Wilson, Richard; Kolander, Cheryl A. (2003). Drug abuse prevention: a school and community partnership. Sudbury, Mass.: Jones and Bartlett. pp. 40â45. ISBN 978-0-7637-1461-1. http://books.google.com/?id=Cm1MfcBSucUC.
- ^ MΓΌller D, Koch RD, von Specht H, VΓΆlker W, MΓΌnch EM (March 1985). "[Neurophysiologic findings in chronic alcohol abuse]" (in German). Psychiatr Neurol Med Psychol (Leipz) 37 (3): 129â32. PMID 2988001.
- ^ Testino G (2008). "Alcoholic diseases in hepato-gastroenterology: a point of view". Hepatogastroenterology 55 (82â83): 371â7. PMID 18613369.
- ^ Mihai, B.; LäcätuÅu, C.; Graur, M. (April-June 2008). "[Alcoholic ketoacidosis]". Rev Med Chir Soc Med Nat Iasi 112 (2): 321â6. PMID 19294998.
- ^ a b Professor Georgy Bakalkin (8 July 2008). "Alcoholism-associated molecular adaptations in brain neurocognitive circuits". eurekalert.org. http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php. Retrieved 14 February 2009.
- ^ Oscar-Berman, Marlene; Marinkovic, Ksenija (2003). "Alcoholism and the brain: an overview". Alcohol Res Health 27 (2): 125â33. PMID 15303622.
- ^ Wetterling T; Junghanns, K (September 2000). "Psychopathology of alcoholics during withdrawal and early abstinence". Eur Psychiatry 15 (8): 483â8. doi:10.1016/S0924-9338(00)00519-8. ISSN 0924-9338. PMID 11175926.
- ^ Schuckit MA (November 1983). "Alcoholism and other psychiatric disorders". Hosp Community Psychiatry 34 (11): 1022â7. ISSN 0022-1597. PMID 6642446.
- ^ Cowley DS (January 24, 1992). "Alcohol abuse, substance abuse, and panic disorder". Am J Med 92 (1A): 41Sâ48S. doi:10.1016/0002-9343(92)90136-Y. ISSN 0002-9343. PMID 1346485.
- ^ Cosci F; Schruers, KR; Abrams, K; Griez, EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry 68 (6): 874â80. doi:10.4088/JCP.v68n0608. ISSN 0160-6689. PMID 17592911.
- ^ Grant BF, Harford TC (October 1995). "Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey". Drug Alcohol Depend 39 (3): 197â206. doi:10.1016/0376-8716(95)01160-4. ISSN 0376-8716. PMID 8556968. http://linkinghub.elsevier.com/retrieve/pii/0376871695011604.
- ^ Kandel DB, Huang FY, Davies M (October 2001). "Comorbidity between patterns of substance use dependence and psychiatric syndromes". Drug Alcohol Depend 64 (2): 233â41. doi:10.1016/S0376-8716(01)00126-0. ISSN 0376-8716. PMID 11543993.
- ^ Cornelius JR, Bukstein O, Salloum I, Clark D (2003). "Alcohol and psychiatric comorbidity". Recent Dev Alcohol 16: 361â74. doi:10.1007/0-306-47939-7_24. ISSN 0738-422X. PMID 12638646.
- ^ Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL (July 1997). "Comparison of induced and independent major depressive disorders in 2,945 alcoholics". Am J Psychiatry 154 (7): 948â57. ISSN 0002-953X. PMID 9210745. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=9210745.
- ^ Schuckit MA, Tipp JE, Bucholz KK (October 1997). "The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls". Addiction 92 (10): 1289â304. doi:10.1111/j.1360-0443.1997.tb02848.x. ISSN 0965-2140. PMID 9489046. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=1997&volume=92&issue=10&spage=1289.
- ^ Schuckit MA, Smith TL, Danko GP (November 2007). "A comparison of factors associated with substance-induced versus independent depressions". J Stud Alcohol Drugs 68 (6): 805â12. ISSN 1937-1888. PMID 17960298.
- ^ Schuckit M (June 1983). "Alcoholic patients with secondary depression". Am J Psychiatry 140 (6): 711â4. ISSN 0002-953X. PMID 6846629. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=6846629.
- ^ a b c d Karrol Brad R. (2002). "Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of social work 2 (3): 337â356. doi:10.1177/146801730200200305.
- ^ a b c McCully, Chris (2004). Goodbye Mr. Wonderful. Alcohol, Addition and Early Recovery.. London: Jessica Kingsley Publishers. ISBN 978-1-84310-265-6. http://www.jkp.com/catalogue/book/9781843102656/contents.
- ^ Isralowitz, Richard (2004). Drug use: a reference handbook. Santa Barbara, Calif.: ABC-CLIO. pp. 122â123. ISBN 978-1-57607-708-5. http://books.google.com/?id=X0mxxfbIbp4C.
- ^ Langdana, Farrokh K. (27 March 2009). Macroeconomic Policy: Demystifying Monetary and Fiscal Policy (2nd ed.). Springer. p. 81. ISBN 978-0-387-77665-1. http://books.google.com/?id=GCYWQn79JYwC.
- ^ Galanter, Marc; Kleber, Herbert D. (1 July 2008). The American Psychiatric Publishing Textbook of Substance Abuse Treatment (4th ed.). United States of America: American Psychiatric Publishing Inc. p. 58. ISBN 978-1-58562-276-4. http://books.google.com/?id=6wdJgejlQzYC.
- ^ a b Dart, Richard C. (1 December 2003). Medical Toxicology (3rd ed.). USA: Lippincott Williams & Wilkins. pp. 139â140. ISBN 978-0-7817-2845-4. http://books.google.com/?id=qDf3AO8nILoC.
- ^ Idemudia SO, Bhadra S, Lal H (June 1989). "The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin". Neuropsychopharmacology 2 (2): 115â22. doi:10.1016/0893-133X(89)90014-6. ISSN 0893-133X. PMID 2742726.
- ^ Chastain, G (October 2006). "Alcohol, neurotransmitter systems, and behavior.". The Journal of general psychology 133 (4): 329â35. doi:10.3200/GENP.133.4.329-335. ISSN 0022-1309. PMID 17128954.
- ^ Martinotti G; Nicola, MD; Reina, D; Andreoli, S; FocΓ , F; Cunniff, A; Tonioni, F; Bria, P et al. (2008). "Alcohol protracted withdrawal syndrome: the role of anhedonia". Subst Use Misuse 43 (3â4): 271â84. doi:10.1080/10826080701202429. ISSN 1082-6084. PMID 18365930.
- ^ Stojek A; Madejski, J; Dedelis, E; Janicki, K (MayâJune 1990). "[Correction of the symptoms of late substance withdrawal syndrome by intra-conjunctival administration of 5% homatropine solution (preliminary report)]". Psychiatr Pol 24 (3): 195â201. ISSN 0033-2674. PMID 2084727.
- ^ Le Bon O; Murphy, JR; Staner, L; Hoffmann, G; Kormoss, N; Kentos, M; Dupont, P; Lion, K et al. (August 2003). "Double-blind, placebo-controlled study of the efficacy of trazodone in alcohol post-withdrawal syndrome: polysomnographic and clinical evaluations". J Clin Psychopharmacol 23 (4): 377â83. doi:10.1097/01.jcp.0000085411.08426.d3. ISSN 0271-0749. PMID 12920414.
- ^ Sanna, E; Mostallino, Mc; Busonero, F; Talani, G; Tranquilli, S; Mameli, M; Spiga, S; Follesa, P et al. (17 December 2003). "Changes in GABA(A) receptor gene expression associated with selective alterations in receptor function and pharmacology after ethanol withdrawal". The Journal of neuroscience : the official journal of the Society for Neuroscience 23 (37): 11711â24. ISSN 0270-6474. PMID 14684873. http://www.jneurosci.org/cgi/content/full/23/37/11711.
- ^ Idemudia SO, Bhadra S, Lal H (June 1989). "The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin". Neuropsychopharmacology 2 (2): 115â22. doi:10.1016/0893-133X(89)90014-6. PMID 2742726.
- ^ a b c d Enoch, MA. (Dec 2006). "Genetic and environmental influences on the development of alcoholism: resilience vs. risk.". Ann N Y Acad Sci 1094: 193â201. doi:10.1196/annals.1376.019. PMID 17347351.
- ^ Bierut, LJ.; Schuckit, MA.; Hesselbrock, V.; Reich, T. (2000). "Co-occurring risk factors for alcohol dependence and habitual smoking.". Alcohol Res Health 24 (4): 233â41. PMID 15986718.
- ^ Agrawal, Arpana; Sartor, Carolyn E.; Lynskey, Michael T.; Grant, Julia D.; Pergadia, Michele L.; Grucza, Richard; Bucholz, Kathleen K.; Nelson, Elliot C. et al. (2009). "Evidence for an Interaction Between Age at First Drink and Genetic Influences on DSM-IV Alcohol Dependence Symptoms". Alcoholism: Clinical and Experimental Research 33 (12): 2047. doi:10.1111/j.1530-0277.2009.01044.x. PMID 19764935.
- ^ a b "Early Age At First Drink May Modify Tween/Teen Risk For Alcohol Dependence". Medical News Today. 21 September 2009. http://www.medicalnewstoday.com/articles/164576.php.
- ^ Schwandt, M.L.; S.G. Lindell, S. Chen, J.D. Higley, S.J. Suomi, M. Heilig, C.S. Barr (Feb 2010). "Alcohol response and consumption in adolescent rhesus macaques". Alcohol 44 (1): 67â80. doi:10.1016/j.alcohol.2009.09.034. PMID 20113875.
- ^ Crews, FT.; Boettiger, CA. (Sep 2009). "Impulsivity, frontal lobes and risk for addiction.". Pharmacol Biochem Behav 93 (3): 237â47. doi:10.1016/j.pbb.2009.04.018. PMID 19410598.
- ^ Moore, S.; Montane-Jaime, LK.; Carr, LG.; Ehlers, CL. (2007). "Variations in alcohol-metabolizing enzymes in people of East Indian and African descent from Trinidad and Tobago.". Alcohol Res Health 30 (1): 28â30. PMID 17718398.
- ^ Eng, MY.; Luczak, SE.; Wall, TL. (2007). "ALDH2, ADH1B, and ADH1C genotypes in Asians: a literature review.". Alcohol Res Health 30 (1): 22â7. PMID 17718397.
- ^ Scott, DM.; Taylor, RE. (2007). "Health-related effects of genetic variations of alcohol-metabolizing enzymes in African Americans.". Alcohol Res Health 30 (1): 18â21. PMID 17718396.
- ^ Ehlers, CL. (2007). "Variations in ADH and ALDH in Southwest California Indians.". Alcohol Res Health 30 (1): 14â7. PMID 17718395.
- ^ Szlemko, WJ.; Wood, JW.; Thurman, PJ. (Oct 2006). "Native Americans and alcohol: past, present, and future.". J Gen Psychol 133 (4): 435â51. doi:10.3200/GENP.133.4.435-451. PMID 17128961.
- ^ Spillane, NS.; Smith, GT. (May 2007). "A theory of reservation-dwelling American Indian alcohol use risk.". Psychol Bull 133 (3): 395â418. doi:10.1037/0033-2909.133.3.395. PMID 17469984.
- ^ Ewing JA (October 1984). "Detecting alcoholism. The CAGE questionnaire". JAMA : the journal of the American Medical Association 252 (14): 1905â7. doi:10.1001/jama.252.14.1905. ISSN 0098-7484. PMID 6471323.
- ^ "CAGE questionnaire â screen for alcohol misuse" (PDF). http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf.
- ^ Dhalla, S.; Kopec, JA. (2007). "The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies.". Clin Invest Med 30 (1): 33â41. PMID 17716538.
- ^ Raistrick, D.; Dunbar, G. Davidson, R. (1983). "Alcohol Dependence Data Questionnaire (SADD)". European Monitoring Centre for Drugs and Drug Addiction. http://www.emcdda.europa.eu/html.cfm/index3556EN.html.
- ^ "Michigan Alcohol Screening Test". The National Council on Alcoholism and Drug Dependence. http://www.ncadd-sfv.org/symptoms/mast_test.html.
- ^ Thomas F. Babor; John C. Higgins-Biddle, John B. Saunders, Maristela G. Monteiro (2001). "The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care" (PDF). World Health Organization. http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf.
- ^ Smith, SG; Touquet, R; Wright, S; Das Gupta, N (September 1996). "Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)". Journal of Accident and Emergency Medicine (British Association for Accident and Emergency Medicine) 13 (5): 308â312. doi:10.1093/alcalc/agh049. ISSN 1351-0622. PMID 8894853.
- ^ a b Nurnberger, Jr., John I., and Bierut, Laura Jean. "Seeking the Connections: Alcoholism and our Genes." Scientific American, Apr 2007, Vol. 296, Issue 4.
- ^ New York Daily News (William Sherman) Test targets addiction gene 11 February 2006
- ^ Berggren U, Fahlke C, Aronsson E (September 2006). "The taqI DRD2 A1 allele is associated with alcohol-dependence although its effect size is small" (Free full text). Alcohol and alcoholism (Oxford, Oxfordshire) 41 (5): 479â85. doi:10.1093/alcalc/agl043. ISSN 0735-0414. PMID 16751215. http://alcalc.oxfordjournals.org/cgi/content/full/41/5/479.
- ^ Jones, AW. (2006). "Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship.". Toxicol Rev 25 (1): 15â35. doi:10.2165/00139709-200625010-00002. PMID 16856767.
- ^ Das, SK.; Dhanya, L.; Vasudevan, DM. (2008). "Biomarkers of alcoholism: an updated review.". Scand J Clin Lab Invest 68 (2): 81â92. doi:10.1080/00365510701532662. PMID 17852805.
- ^ World Health Organisation (2010). "Alcohol". http://www.who.int/topics/alcohol_drinking/en/.
- ^ "Alcohol policy in the WHO European Region: current status and the way forward" (PDF). World Health Organisation. 12 September 2005. http://www.euro.who.int/document/mediacentre/fs1005e.pdf.
- ^ Crews, F.; He, J.; Hodge, C. (Feb 2007). "Adolescent cortical development: a critical period of vulnerability for addiction.". Pharmacol Biochem Behav 86 (2): 189â99. doi:10.1016/j.pbb.2006.12.001. PMID 17222895.
- ^ a b Gabbard, Glen O. (2001). Treatments of psychiatric disorders (3 ed.). Washington, DC: American Psychiatric Press. ISBN 978-0-88048-910-2. http://books.google.com/?id=hLVrAAAAMAAJ.
- ^ Dawson, Deborah A.; Grant, Bridget F.; Stinson, Frederick S.; Chou, Patricia S.; Huang, Boji; Ruan, W. June (2005). "Recovery from DSM-IV alcohol dependence: United States, 2001â2002". Addiction 100 (3): 281. doi:10.1111/j.1360-0443.2004.00964.x. PMID 15733237. http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm.
- ^ Dawson, Deborah A.; Goldstein, RisΓ« B.; Grant, Bridget F. (2007). "Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up". Alcoholism: Clinical and Experimental Research 31 (12): 2036. doi:10.1111/j.1530-0277.2007.00536.x. PMID 18034696.
- ^ Vaillant, GE (2003). "A 60-year follow-up of alcoholic men". Addiction (Abingdon, England) 98 (8): 1043â51. PMID 12873238.
- ^ a b Krampe H, Stawicki S, Wagner T (January 2006). "Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome". Alcoholism, clinical and experimental research 30 (1): 86â95. doi:10.1111/j.1530-0277.2006.00013.x. ISSN 0145-6008. PMID 16433735.
- ^ Ogborne, AC. (June 2000). "Identifying and treating patients with alcohol-related problems.". CMAJ 162 (12): 1705â8. PMID 10870503.
- ^ Soyka, M.; RΓΆsner, S. (Nov 2008). "Opioid antagonists for pharmacological treatment of alcohol dependence â a critical review.". Curr Drug Abuse Rev 1 (3): 280â91. PMID 19630726.
- ^ U.S. Patent No. 4,882,335 (issued Nov. 21, 1989), available at: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=4882335.PN.&OS=PN/4882335&RS=PN/4882335
- ^ Mason, BJ.; Heyser, CJ. (Jan 2010). "The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence.". Expert Opin Drug Saf 9 (1): 177â88. doi:10.1517/14740330903512943. PMID 20021295.
- ^ Olmsted CL, Kockler DR (October 2008). "Topiramate for alcohol dependence". Ann Pharmacother 42 (10): 1475â80. doi:10.1345/aph.1L157. ISSN 1060-0280. PMID 18698008.
- ^ Kenna, GA.; Lomastro, TL.; Schiesl, A.; Leggio, L.; Swift, RM. (May 2009). "Review of topiramate: an antiepileptic for the treatment of alcohol dependence.". Curr Drug Abuse Rev 2 (2): 135â42. PMID 19630744.
- ^ Lindsay, S.J.E.; Powell, Graham E., eds (28 July 1998). The Handbook of Clinical Adult Psychology (2nd ed.). Routledge. p. 402. ISBN 978-0-415-07215-1. http://books.google.com/?id=a6A9AAAAIAAJ&pg=PA380.
- ^ Gitlow, Stuart (1 October 2006). Substance Use Disorders: A Practical Guide (2nd ed.). USA: Lippincott Williams and Wilkins. pp. 52 and 103â121. ISBN 978-0-7817-6998-3. http://books.google.com/?id=rbrSdWVerBUC.
- ^ Kushner MG, Abrams K, Borchardt C (March 2000). "The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings". Clin Psychol Rev 20 (2): 149â71. doi:10.1016/S0272-7358(99)00027-6. PMID 10721495. http://linkinghub.elsevier.com/retrieve/pii/S0272-7358(99)00027-6.
- ^ Poulos CX, Zack M (November 2004). "Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers". Behav Pharmacol 15 (7): 503â12. doi:10.1097/00008877-200411000-00006. ISSN 0955-8810. PMID 15472572.
- ^ Catherine Le GalΓ¨s-Camus (2004) (PDF). Global Status Report on Alcohol 2004. World Health Organization. ISBN 92-4-156272-2. http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf.
- ^ a b "Alcohol misuse: How much does it cost?" (PDF). Cabinet Office Strategy Unit. September 2003. http://www.strategy.gov.uk/downloads/files/econ.pdf.
- ^ Hasin D et al. (2007). "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States". Archives of General Psychiatry 64 (7): 830. doi:10.1001/archpsyc.64.7.830. PMID 17606817.
- ^ "alcoholism". EncyclopΓ¦dia Britannica. 2010. http://www.britannica.com/EBchecked/topic/13448/alcoholism.
- ^ Dick DM, Bierut LJ (April 2006). "The genetics of alcohol dependence". Current psychiatry reports 8 (2): 151â7. doi:10.1007/s11920-006-0015-1. ISSN 1523-3812. PMID 16539893.
- ^ The National Institute on Alcohol Abuse and Alcoholism; U.S. Department of Health and Human Services, NIH News (18 January 2005). "2001â2002 Survey Finds That Many Recover From Alcoholism". National Institutes of Health. http://www.nih.gov/news/pr/jan2005/niaaa-18.htm.
- ^ Vaillant GE (August 2003). "A 60-year follow-up of alcoholic men". Addiction. 98 (8): 1043â51. doi:10.1046/j.1360-0443.2003.00422.x. ISSN 0965-2140. PMID 12873238.
- ^ Zuskin, E.; Jukiä, V.; Lipozenciä, J.; Matosiä, A.; Mustajbegoviä, J.; Turciä, N.; Poplasen-Orlovac, D.; Bubas, M. et al. (Dec 2006). "[Alcoholismâhow it affects health and working capacity]". Arh Hig Rada Toksikol 57 (4): 413â26. PMID 17265681.
- ^ O'Connor, Rory; Sheehy, Noel (29 Jan 2000). Understanding suicidal behaviour. Leicester: BPS Books. pp. 33â37. ISBN 978-1-85433-290-5. http://books.google.com/?id=79hEYGdDA3oC.
- ^ Miller, NS; Mahler; Gold (1991). "Suicide risk associated with drug and alcohol dependence.". Journal of addictive diseases 10 (3): 49â61. doi:10.1300/J069v10n03_06. ISSN 1055-0887. PMID 1932152.
- ^ Potter, James V. (14 January 2008). Substances of Abuse. 2. AFS Publishing Co. pp. 1â13. ISBN 978-1-930327-46-7. http://books.google.com/?id=WU73eJAIDI4C&pg=PA1.
- ^ Julie Louise Gerberding; JosΓ© Cordero, R. Louise Floyd (May 2005). "Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis" (PDF). USA: Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf.
- ^ Streissguth, Ann Pytkowicz (1 September 1997). Fetal alcohol syndrome: a guide for families and communities. Baltimore, MD, USA: Paul H Brookes Pub.. ISBN 978-1-55766-283-5. http://books.google.com/?id=kptHAAAAMAAJ.
- ^ "Global Status Report on Alcohol 2004" (PDF). World Health Organization. http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf. Retrieved 3 January 2007.
- ^ "Economic cost of alcohol consumption". World Health Organization Global Alcohol Database. http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2. Retrieved 3 January 2007.
- ^ "Q&A: The costs of alcohol". BBC. 19 September 2003. http://news.bbc.co.uk/1/hi/health/3122244.stm.
- ^ "World/Global Alcohol/Drink Consumption". Finfacts Ireland. 2009. http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm.
- ^ Stivers, Richard (May 2000). Hair of the dog: Irish drinking and its American stereotype. New York: Continuum. ISBN 978-0-8264-1218-8. http://books.google.com/?id=MH3aAAAAMAAJ.
- Galanter, Marc (2005). Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, Treatment. New York, NY: Kluwer Academic/Plenum. ISBN 0-306-48625-3. OCLC 56653179 57724687 71290784 133155628 56653179 57724687 71290784.
- Hedblom, Jack H. (2007). Last Call: Alcoholism and Recovery. Baltimore, MD: Johns Hopkins University Press. ISBN 978-0-8018-8677-5. OCLC 77708730 237901552 77708730.
- National Institute on Alcohol Abuse and Alcoholism. "Etiology and Natural History of Alcoholism".
- O'Farrell, Timothy J. and William Fals-Stewart (2006). Behavioral Couples Therapy for Alcoholism and Drug Abuse. New York, NY: Guilford Press. ISBN 1-59385-324-6. OCLC 64336035.
- Pence, Gregory, "Kant on Whether Alcoholism is a Disease," Ch. 2, The Elements of Bioethics, McGraw-Hill Books, 2007 ISBN 0-07-313277-2.
- Plant, Martin A. and Moira Plant (2006). Binge Britain: Alcohol and the National Response. Oxford, UK; New York, NY: Oxford University Press. ISBN 0-19-929940-4. OCLC 64554668 238809013 64554668.
- Smart, Lesley (2007). Alcohol and Human Health. Oxford, UK: Oxford University Press. ISBN 978-0-19-923735-7. OCLC 163616466.
- Sutton, Philip M. (2007). "Alcoholism and Drug Abuse". in Michael L. Coulter, Stephen M. Krason, Richard S. Myers, and Joseph A. Varacalli. Encyclopedia of Catholic Social Thought, Social Science, and Social Policy. Lanham, MD; Toronto, Canada; Plymouth, UK: Scarecrow Press. pp. 22â24. ISBN 978-0-8108-5906-7.
- Thompson, Warren, MD, FACP. "Alcoholism." Emedicine.com, June 6, 2007. Retrieved 2007-09-02.
Psychoactive substance-related disorder (F10âF19, 291â292; 303â305)
This article is based on one or more articles in Wikipedia, with modifications and
additional content by SOURCES editors. This article is covered by a Creative Commons
Attribution-Sharealike 3.0 License (CC-BY-SA) and the GNU Free Documentation License
(GFDL). The remainder of the content of this website, except where otherwise indicated,
is copyright SOURCES and may not be reproduced without written permission.
(For information call 416-964-7799 or use the
SOURCES.COM is an online portal and directory for journalists, news media, researchers
and anyone seeking experts, spokespersons, and reliable information resources. Use
SOURCES.COM to find experts, media contacts, news releases, background information,
scientists, officials, speakers, newsmakers, spokespeople, talk show guests, story
ideas, research studies, databases, universities, associations and NGOs, businesses,
government spokespeople. Indexing and search applications by Ulli Diemer and Chris
For information about being included in SOURCES as a expert or
spokesperson see the FAQ or use
the online membership form.
Check here for
information about becoming an
For partnerships, content and applications, and domain name opportunities
Sources home page